A Dermatologist Talks With Norma Libman

`We Are In An Epidemic Of Skin Cancer In The World`

August 13, 1989|By Norma Libman.

Name: Edward B. Lack, M.D., S.C.

Occupation: Dermatologist

Background: Born in Chicago, Lack, 45, earned his medical degree at the University of Missouri in 1969. He served as a family practitioner and as an emergency room doctor before starting his own dermatology practice in 1973. Lack, whose practice is in Des Plaines, lives in Highland Park with his wife and 9-year-old son.

Years in present position: 17

When I first started in practice, and up until recently, patients thought that dermatologists were not doctors. Often a patient would come in, and he`d have something wrong that was related to a respiratory infection, or whatever, and I`d say I want to listen to his lungs and he would say, ``Well, I`ll see my real doctor for that.``

My background had been in family practice and three years of emergency medicine. So I felt like a ``real`` doctor, and I resented that attitude, as did a lot of dermatologists around the country. Now, because of the work we`ve done in immunology, especially in cancer, and now that we`ve become fairly proficient surgeons, I think we`re perceived pretty much by the public as ``real`` doctors.

We dermatologists pioneered hair transplants. We pioneered liposuction. We did a lot of the pioneering work in sclerotherapy (treatment of varicose veins). After we got more proficient in those areas, we started teaching and setting up postgraduate courses. And that`s how I came to expand my own training. I do surgery and I do a lot of counseling and I work in

cosmetology-making people look better and feel better. We are family practitioners of the skin. If it has skin, I do it. It isn`t that I know everything; it`s that there`s no one better trained to help with the skin.

Sometimes we`re dealing with people who have multisystem disease. Maybe they have something wrong with the liver, the kidney and the skin. Maybe they have diabetes. Well, then you have to have a team of doctors. None of us knows enough to manage it all.

Practicing medicine is very satisfying. You have a patient who suffers, you do something, the patient gets well, and you get a lot of gratitude from that person, in most cases. This is fun because it`s exciting and there`s a beginning and an end.

Of course there are some aspects to this profession that I don`t like. I don`t like it when people get upset with me because they`re carrying problems from home or they had to wait a while in the waiting room. Waiting in the waiting room is always the crucial issue people focus on. I don`t like being accused of trying to inconvenience them when my only goal and role here is to help people.

Another major negative aspect to this profession is related to the adversarial environment in which we live. Many patients come in with a hostile attitude. They let you know that they have ``a lawyer.`` Some will make a snide remark, such as, ``You know, if you don`t do well, I`m going to sue you.`` To be sure, this is a minority, and most of my patients are not like that. Maybe it`s two or three people in a day. But they take so much emotional energy out of you. They always upset the front-office staff, too.

This constant fear of a lawsuit is very real. In this country, because the loser does not have to pay for court costs, you can sue with absolute abandon. You have no penalty, and, therefore, the majority of lawsuits against doctors are frivolous. Also, there is an attitude that you should be rewarded for your injury. Not just a restitution, enough money to help you get well, but a reward, as if you had won a lottery.

On a typical day I get up around 6 a.m. and leave the house by 6:30 or 6:45. I`m at either Holy Family or Lutheran General Hospital by 7:15 or 7:30. I have breakfast with employees or with the few doctors who might be around, and then I come to the office. I`ll see patients for three to four hours and then we take a break, at which time I`ll take 15 to eat and 45 minutes to do administrative work. Then we`ll resume seeing patients for another three to four hours. After that I do paperwork and make phone calls for another hour. The phone calls could be to get test results or maybe because I got a test result and I don`t believe it and I have to find out why it was the way it was. Then I may have to go to the hospital to do consultations on other doctors` patients. If I`m lucky I`ll get out at 5:30. If not, it might be 6:30 or 7. If I have committee meetings, those would either start my day or end my day. Sometimes I`m teaching or have a resident working with me to watch and learn.

The most common reasons people see a skin doctor are to look better or to feel better. They`re itching and they`re uncomfortable. Or they want to look better and they may or may not have a disease. Acne, for instance, is a typical reason to consult a dermatologist.